Background The watch-and-wait (W&W) strategy is a novel treatment option for patients with rectal cancer who have a strong desire for organ preservation. The study aimed to explore the long-term outcomes of the W&W strategy in a large cohort of rectal cancer patients who achieved a clinical complete response (cCR) after consolidation total neoadjuvant therapy (TNT), and to compare with patients who achieved a pathological complete response (pCR) after radical surgery. Methods The W&W group comprised patients who were assessed as having a cCR after consolidation TNT and adopted the W&W strategy. Patients who underwent standard resection and achieved a pCR were compared as a reference. Inverse probability of treatment weighting (IPTW)-adjusted Kaplan-Meier analysis with log-rank test was used to compare survival outcomes. Results We included 89 and 171 patients in the W&W and pCR groups, respectively. The median follow-up period was 45 and 58 months for the W&W and pCR groups, respectively. After IPTW adjustment, the 2-year local regrowth/recurrence rate for the W&W and pCR groups were 9.9% and 2.0%, respectively (p < 0.001). The W&W and pCR groups had similar 5-year outcomes, including overall survival, disease-free survival, and distant metastasis-free survival (all p > 0.05). No significant difference was observed in the rates of distant metastasis between patients in the W&W group with local regrowth and those without local regrowth (25% versus 6.2%, p = 0.119). Conclusion Patients who were managed with a W&W strategy after consolidation TNT had favorable survival outcomes, which were similar to those of patients with a pCR. The rate of local regrowth in W&W patients was lower in our study than in other studies as a result of the implementation of consolidation TNT.

中文翻译：

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总体新辅助治疗后完全缓解的直肠癌患者回顾性队列的长期结果：倾向评分加权分析。

背景对于强烈希望保留器官的直肠癌患者来说，观察等待（W＆W）策略是一种新颖的治疗选择。该研究旨在探讨 W&W 策略对一大批在巩固总新辅助治疗 (TNT) 后达到临床完全缓解 (cCR) 的直肠癌患者的长期结果，并与达到病理完全缓解 (cCR) 的患者进行比较根治性手术后的反应（pCR）。方法 W&W 组由巩固 TNT 后评估为 cCR 并采用 W&W 策略的患者组成。将接受标准切除并达到 pCR 的患者作为参考进行比较。使用对数秩检验的治疗加权逆概率 (IPTW) 调整 Kaplan-Meier 分析来比较生存结果。结果 W&W 组和 pCR 组分别纳入了 89 名和 171 名患者。W&W 组和 pCR 组的中位随访期分别为 45 个月和 58 个月。IPTW 调整后，W&W 组和 pCR 组的 2 年局部再生/复发率分别为 9.9% 和 2.0% (p < 0.001)。W&W 组和 pCR 组具有相似的 5 年结果，包括总生存期、无病生存期和无远处转移生存期（均 p > 0.05）。W&W 组中局部再生和无局部再生的患者之间的远处转移率没有显着差异（25% vs 6.2%，p = 0.119）。结论 巩固 TNT 后采用 W&W 策略治疗的患者具有良好的生存结果，与 pCR 患者相似。由于实施了巩固 TNT，我们的研究中 W&W 患者的局部再生率低于其他研究。